Pancreaticoduodenectomy, pylorus-preserving, partial (OP according to Traverso)

The approach is a cranially convex transverse upper abdominal laparotomy. Subsequently, the exploration phase involves inspection and palpation of the entire abdomen to exclude distant metastases and signs of local unresectability.

Alternatively, in cases of a very acute costal arch angle, a median laparotomy can be performed.

After clamping the gallbladder, the subserosal preparation of the gallbladder from the liver bed is performed, transecting the cystic duct and cystic artery under appropriate ligatures, and the specimen is sent for histology.

Tip: To prevent ascending cholangitis after biliodigestive anastomosis, cholecystectomy is mandatory for functional reasons during pancreatic head resection.

After inspection and palpation of the pancreas from the ventral side, the omental bursa is opened by detaching the greater omentum from the transverse colon.

After mobilization of the right colonic flexure, the Kocher's mobilization of the duodenum is performed.

The palpation of the mobilized pancreatic head is performed to exclude retroperitoneal infiltration, as well as the palpation of the lymphatic drainage pathways and the major vessels. This is followed by the commencement of the preparation of the hepatoduodenal ligament.

The transection of the right gastric artery under ligatures marks the beginning of the mobilization of the pylorus or antrum.

The transection of the postpyloric duodenum is performed with the ILA-52.

Tip: Early transection of the duodenum significantly facilitates lymphadenectomy in pylorus-preserving partial pancreaticoduodenectomy.

The lymphadenectomy is performed centrally along the proper hepatic artery in the hepatoduodenal ligament.

Tip: The right hepatic artery runs laterally dorsal in the hepatoduodenal ligament; attention should be paid to a possible atypical course of the right hepatic artery that arises separately from the superior mesenteric artery!

The common bile duct is transected and a previously inserted stent is removed.

Tip: For reasons of blood supply, the common bile duct should be transected near the hilum, proximal to the cystic duct junction.

The gastroduodenal artery is transected under ligation.

The lymphadenectomy from the hepatoduodenal ligament is continued to the celiac trunk.